CONTRACTOR’S HSE EQUIPMENT PRE-MOBILIZATION CHECK LIST

DATE: ………………………………………………….

PROJECT TITLE: ……………………………………………………………………………………………………………………………......

CONTRACTOR: ………………………………………………………………………………………………………………………………….

CONTRACT NO: ………………………………………………………………………………………………………………………………….

LOCATION: ……………………………………………………………………………………………………………………………………….

DEPARTMENT: …………………………………………………………………………………………………………………………………….

S/N DESCRIPTION (REQUIREMENTS) AVAILABLE QTY CHECKED

Y/N (OK) Y/N
1 HSE PLAN
2 SECURITY PLAN
3 HARD HAT

This document when printed is an uncontrolled copy

4 COVERALL (Long sleve with Printed company’s name)
5 RAIN COAT
6 HAND GLOVE
7 SAFETY SHOE
8 SAFETY BOOT/STEEL TOE RAIN BOOT
9 EYE GOGGLE ( Specified)
10 WELDING SHIELD
11 NOSE MASK ( Respirators as Specified)
12 DUSK MASK
12 EAR MUFF
13 SAFETY HARNESS
14 LIFE VEST
15 FIRST AID BOX WITH ADEQUATE CONTENT & FIRST
AID ADMINISTRATION REGISTER
16 FIRE EXTINGUISHER WITH VALID INSPECTION DATE
17 MAN HOUR BOARED 1
18 NOTICE BOARED 1
19 ADEQUATE WARNING SIGNS
20 NO PPE NO ENTRY 2nos
NO ENTRY TO UNAUTHORISED PERSON 2nos
MUSTER POINT 1no
WASTE DUMP KEEP OFF 1no
FLYING OBJECT WATCH OUT 2nos
FALLING OBJECT KEEP OFF 2nos
21 CAUTION TAPES 1 roll
22 HSE OFFICER COMPETENCY (NISP LEVEL 3)
23 FIRST AIDER QUALIFICATIONS
24 NOTE BOOKS 6nos
25 SUPERVISOR AND HSE OFFICER APPOINTMENT
LETTER
26 BOX AND FLAT FILE 1/1
27 RETAINERSHIP CLINIC WITH EVIDENCE
28 MEDICAL CERTIFICATES OF PERSONNEL
29 DRINKING WATER FACILITIES (CUPS)
30 EMERGENCY ALART SYSTEM
31 LIST OF WORKERS WITH PHOTO COPY OF COMPANY
ID CARDS
32 KICK-OFF MEETING SIGNED OFF
33 HEMP TRAINING SIGNED OFF
34 OFFICE SPACE

This is to certify that the contractor has met all HSE Requirements to Mobilize to site and commence work
 This document when printed is an uncontrolled copy
IFM HSE Support.
CONTRACTOR’S REP:
Sign: